The management of large skeletal defects continues to present a major challenge to orthopaedic surgeons, particularly when the problem arises in young patients in whom artificial devices and joint implants are likely to lead to early failure. Both cemented111,145 and uncemented60,75,139 devices have been shown to have significant and potential complications in young adults and children.
For example, there is a marked increase in the use of large frozen cortical bone allografts in limb-sparing procedures. These are used in the treatment of bone tumors19,26,44,48,77,104,105,107,112,146,159, for repair of massive bone loss due to traumatic injury69,99, in the treatment of a vascular necrosis12, and, increasingly, in failed joint arthroplasties, where extensive bone loss due to osteolysis is commonly encountered47,56,76,109,125,130. Even though the overall success rate for massive cortical bone allografts, as measured by return to work and engagement in relatively normal activities without crutches or braces, is approximately 75-85%, only 50% of these patients have an entirely uncomplicated postoperative course. About a quarter of the total group require reoperations such as autologous grafting or replating for stress fractures4,5,32,103 or delayed unions5,43,70,71,103-105,127. Some patients require excision of the graft because of infection98,149,150, reimplantation, long-term bracing or, in some cases, amputation. These results clearly indicate that problems still exist with this procedure and that if the technique is to be more widely applied, it must be more extensively examined and materially improved. Therefore, development of a biologic alternative seems eminently worthwhile.